Emekli Emre, Gündoğdu Elif
Department of Radiology, School of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
Pol J Radiol. 2020 Feb 19;85:e104-e109. doi: 10.5114/pjr.2020.93399. eCollection 2020.
Pancreaticoduodenectomy (the Whipple procedure) is the only potential curative treatment for periampullary tumours. Although mortality due to the procedure is gradually decreasing, the morbidity rates remain high. This study aimed to evaluate early computed tomography (CT) findings in patients suspected of complications following the Whipple procedure.
The CT images of patients who underwent the conventional Whipple procedure between January 2015 and January 2019 and underwent CT examination for the detection of early postoperative complications were retrospectively evaluated by two radiologists.
The Whipple operation was performed to 65 patients, and the CT scans of 45 patients (30 males, 15 females) were included in the study. There were no complications in 21 patients. Complications were present in 24 patients (53.33%), of whom 13 had more than one complication. Eight patients had fluid collection in the operation site, two had haematoma, 10 had an abscess, and five had a pancreatic fistula. In addition, a hepatic abscess was detected in one patient, delayed gastric emptying in six patients, anastomotic leakage from the gastrojejunostomy line in two patients, superior mesenteric vein (SMV) thrombosis in two patients, and intraluminal haemorrhage and active extravasation in one patient. Mortality due to complications occurred in one patient in the early postoperative period. Other complications were treated by spontaneous, surgical or percutaneous interventional procedures.
Despite the decreasing mortality rates in recent years, the Whipple procedure is risky and has high morbidity even when performed in experienced centres. CT is the adequate imaging modality for the evaluation of this anatomically altered region and detection of complications.
胰十二指肠切除术（惠普尔手术）是壶腹周围肿瘤唯一可能的根治性治疗方法。尽管该手术导致的死亡率在逐渐下降，但发病率仍然很高。本研究旨在评估疑似惠普尔手术后并发症患者的早期计算机断层扫描（CT）表现。
回顾性评估2015年1月至2019年1月期间接受传统惠普尔手术并因检测术后早期并发症而接受CT检查的患者的CT图像，由两名放射科医生进行评估。
65例患者接受了惠普尔手术，45例患者（30例男性，15例女性）的CT扫描纳入研究。21例患者无并发症。24例患者（53.33%）出现并发症，其中13例有不止一种并发症。8例患者手术部位有积液，2例有血肿，10例有脓肿，5例有胰瘘。此外，1例患者检测到肝脓肿，6例患者出现胃排空延迟，2例患者胃空肠吻合口漏，2例患者肠系膜上静脉（SMV）血栓形成，1例患者管腔内出血和活动性外渗。术后早期有1例患者因并发症死亡。其他并发症通过自发、手术或经皮介入治疗。
尽管近年来死亡率有所下降，但惠普尔手术风险很大，即使在经验丰富的中心进行，发病率也很高。CT是评估这个解剖结构改变区域和检测并发症的合适成像方式。
